If you are eligible for Medicare and have a sufficiently low income, you may qualify for help from certain Medicaid programs in your state. Whether you qualify will depend on:
- Your earned and unearned income, including wages and Social Security payments
- Your assets, including checking accounts, stocks, and some property
- Your nursing care and long-term care needs
- You must meet your state’s functional eligibility criteria (standards for assessing your need for help with activities of daily living, such as, toileting, bathing, and dressing). Each state sets its own standards.
Medicaid programs vary by state, but below are three Medicaid programs available to Medicare beneficiaries in all states. Note that in all of these cases, if you have both Medicare and Medicaid, Medicare will pay first for covered services, and Medicaid will pay second for qualifying costs. If you meet income, asset, and other guidelines in your state, you may qualify for one of the following Medicaid programs:
- Aged, blind, and disabled (ABD) Medicaid: Beneficiaries with ABD Medicaid have coverage for a broad range of health services, including doctors’ visits, hospital care, and medical equipment. ABD Medicaid may also pay for your Medicare cost-sharing. However, ABD Medicaid may not provide adequate coverage if you have long-term care needs.
- Medicaid home and community-based service (HCBS) waiver programs: HCBS waiver programs provide general health coverage and coverage for certain services to help you stay at home or in a community-based setting (for example, in an assisted living facility). Covered services may include personal care, homemaker services, case management, adult day care, skilled nursing care, and therapy services. To qualify, you must meet state-specific functional eligibility criteria.
- Institutional Medicaid: Beneficiaries enrolled in Medicaid for residents in nursing homes—also called Institutional Medicaid—have coverage for nursing home services, including room and board, nursing care, personal care, and therapy services. To qualify, you must require a nursing home level of care or meet state-specific functional eligibility criteria.